Would you have your membranes ruptured if...

[Dot-to-Dot]

...you had my history?  The women in my family all have a history of having very strong amniotic sacs.  They all had pretty good labors, all natural but they all had their water broken.  With my first baby, I decided I wanted to go TOTALLY intervention free, including having my membranes ruptured.  I dilated to 9 with a lip and still no water.  I thought I'd be like one of those women whose sac was bulging out, cushioning the baby and making things less painful.  Ha!  Silly me.  It was hellacious.  And I never had any urge to push.  I wanted it over SO badly that finally I told the doc to just go ahead and break my water!!!  He did and then, bingo bango - we had a baby!

My mom was traumatized watching me (her baby) go through such a loooooong labor and we were both surprised that it was triple the labor that any of the women in our family had had.  Out of concern, she's hoping I'll just have them break the water when I check into the hospital (hopefully, I'll be at least 5 or 6cm at that time).  It seems like such a mild intervention in order to shave many, many hours off my labor.  I wouldn't pin all my hopes on that one thing...but what would be so bad about it, really?

[LiLStar]

I would want to be sure my baby was well positioned first. And probably make it a careful decision as to when. Not just immediately upon admittance! Also, listen to your body. If you feel that its what you need at the time to have your labor progress, or continue to progress smoothly, or resolve a stalled labor, whatever, then you're probably right. You know your body best.

[Dot-to-Dot]

Originally Posted by LiLStar 

I would want to be sure my baby was well positioned first.

I'm not sure how I'd know if the baby was well-positioned or not. 

[LiLStar]

You could ask your OB to palpate the baby and tell you the position. LOA or OA would be optimal, OP, not so much! Check out www.spinningbabies.com. You might be able to practice belly mapping and be able to tell for yourself with some practice. 

[Dot-to-Dot]

He's actually a family doc (I had to fire the first 3 horrendous OB's).  He's wonderful, but unfortunately he didn't know how to do that as of my last birth (just a year and a half ago).  I tried to use spinning babies last time and just could not figure out what I was feeling where.  I have no idea how people know the difference between a foot versus an elbow.  All I have to go on usually are the location of the hiccups and I'm guessing the baby won't have hiccups during labor.  All he could tell me with my first baby was that she was head down when he did the strep exam.  But he didn't know which way she was facing.

[LiLStar]

For me, I would just poke around and feel. I usually felt a big area of firmness on the right or left (indicating roa or loa) with a bunch of limbs on the other side. If I ever felt lots of limbs front and center I tried to encourage some movement, like getting on hands and knees and doing some cat/cows. There was one time in labor with ds when I felt my tummy and could clearly feel that his back was lined up dead center in front. I was THRILLED! I had a c/s with my first because the little stinker wouldn't move out of OP position. I guess that makes me a little more neurotic than most about positioning. For some people OP isn't as big a deal but for me with my first baby.. man, OP vag birth just wasn't happening. And neither was rotation :/ 

[CookAMH]

I would, but late in labor.  Maybe not *as* late as from your first birth, but not as early as you are talking about.

Location of the heartbeat would help with determining position, since it's hard to tell by palpating with a lot of contractions going on.

[meggles]

I see it as a needless intervention. It puts a time limit on your labor if you're having a hospital birth, increases the risk of infection, and can lead to cord problems, among others. You don't know that intact membranes were the cause of your longer labor for sure, do you?

[Smokering]

If the baby's head isn't well descended, there's a slight possibility that AROM could cause a cord prolapse; but the head can be descended pretty well even with an intact sac, so it might not be an issue. On the other hand, don't some hospitals have a policy against women labouring in water after their membranes have ruptured? If you want to labour or birth in a tub, it might pay to ask about that.

Personally I don't think AROM is the worst intervention in the world if it's done mindfully; but it's also very common for the membranes to remain intact throughout most of labour, if they're left alone. (I read a stat on it recently; 80% of membranes don't rupture until - was it 8 cm? Pretty far along, anyway). So it's very possible the length of your previous labour was unrelated. Why not just see how things go?

[womenswisdom]

In order to determine the position, you can ask for a nurse skilled in that to do your cervical check in the hospital.  They can use the fontanelles and suture lines to figure out where baby's head is.

[Tumble Bumbles]

I agree with these.

Originally Posted by meggles 

I see it as a needless intervention. It puts a time limit on your labor if you're having a hospital birth, increases the risk of infection, and can lead to cord problems, among others. You don't know that intact membranes were the cause of your longer labor for sure, do you?

Originally Posted by Smokering 

If the baby's head isn't well descended, there's a slight possibility that AROM could cause a cord prolapse; but the head can be descended pretty well even with an intact sac, so it might not be an issue. On the other hand, don't some hospitals have a policy against women labouring in water after their membranes have ruptured? If you want to labour or birth in a tub, it might pay to ask about that.

Personally I don't think AROM is the worst intervention in the world if it's done mindfully; but it's also very common for the membranes to remain intact throughout most of labour, if they're left alone. (I read a stat on it recently; 80% of membranes don't rupture until - was it 8 cm? Pretty far along, anyway). So it's very possible the length of your previous labour was unrelated. Why not just see how things go?

[Evergreen]

While I definitely think you should be the one to make the decision when the time is right I wanted to let you know that your story sounds a lot like the birth of my 2nd child.

My first baby was born in the caul and it was awesome. My second was a 42 hour labor. My mother kept telling my midwife to break my waters to speed things up and I finally consented. It did nothing to speed things up. It did make it hurt more though which I didn't think would be humanly possible! I think she was positioned poorly and that is why she wouldn't come down despite heavy contractions.

[SubliminalDarkness]

I wouldn't. With my first son, they ruptured the membranes as part of a Pitocin induction. With DS2, who was a cervadil only induction, my water didn't break until his head was coming out. I don't think there's anything unusual about being 9cm and not having an urge to push. You shouldn't be pushing at 9cm in most cases anyway. 

I wouldn't do it. Like someone else said, the cord could prolapse. Or any number of any things 'could' happen that don't need to. 

[Dot-to-Dot]

Originally Posted by SubliminalDarkness 

You shouldn't be pushing at 9cm in most cases anyway. 

I wouldn't do it. Like someone else said, the cord could prolapse. 

I was stuck at 9 because of a cervical lip, they had to push the lip out of the way.  My cervix was swollen and the lip wasn't going anywhere but he asked if I wanted to push as he moved the lip - I did want to!  It was so awful, I'd have been willing to do anything at that point.  I think I remember him saying that once he pushed that lip out of the way, I dilated to 10 immediately, but still no urge to push in the following hour. 

So I've read some things that say these risks are very serious but highly unlikely once you are dilating pretty well, like 7cm or more.  ??
 

[nadia105]

My water has never broken on its own (3 babies, about to have the fourth).  I have never and would never (wihtout a REALLY good reason) consent to it being broken before 8/9 cm or when I was pushing.  With my first, my m/w broke it when I was pushing.  With my second, I was 8cm and she was about to break it when he came barrelling out.  With the third, I had a cervical lip and my mw broke it about the time we were trying to get it out of the way -- 9+ cm. 

Fwiw, my second was my fastest, easiest labor and he must have broken the bag himself on the way out.  It was only 5 hours from the time I realized I was in labor to holding him. 

Chances are your second labor will be very different from your first in a lot of ways, this might not even be an issue at all.  I had many hours shaved off the time off my first labor (13 hours) without any additional interventions. 

One thing to keep in mind is that labor tends to be gentler with the bag intact.  It's not the worst intervention in my opinion, but I wouldn't want it done too early since it puts you on a clock of when you have to deliver. 

[Lisa1970]

I do not think it will make your labor quicker. Maybe at the end, like you did last time, but not sooner. My mother likes to tell me about her short labors. Her longest was 3 hrs. My little sister also had super short labors. And I had longer ones. We are just all different. You probably take after your dad's side. If you do AROM, you will increase your chances of complications and the need for a csect..

[Naturallove]

I think AROM is a almost always needless intervention... I have known babies who are born in the sac which, when they were born they were removed from. In my opinion, the risks of AROM far out way the benefits.

[erigeron]

Personally, I probably would consent to AROM closer to pushing stage if I had your history and baby was properly engaged at that point. I've noticed a lot of rhetoric on Mothering saying "trust your instincts", but when you stepped up and said "I think that AROM was responsible for shortening my labor", that seemed to make some people uncomfortable and they were eager to chalk your long labor up to something else. It's always impossible to know for sure what would have happened if you'd taken a different course of action, so all anyone can do is guess, and your guess is at least as good as anyone else's! It's one thing to get your water broken earlier in labor when the baby is still getting into a good position in your pelvis, but I'm pretty sure that you can wait till a stage where the risk of cord prolapse etc. is negligible, and then make the decision based on what is going on then. I'd at least discuss it with your midwife/OB before you go into labor, so you both have some background on the decision when the time comes.

[Dot-to-Dot]

Thank you erigeron, I appreciate that ackowledgment.